Provider Demographics
NPI:1184848624
Name:HIDALGO, CATHERINE DARCY (PT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:DARCY
Last Name:HIDALGO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 MAE AVE SW
Mailing Address - Street 2:VALLE VISTA ES
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-2822
Mailing Address - Country:US
Mailing Address - Phone:505-836-7739
Mailing Address - Fax:
Practice Address - Street 1:1700 MAE AVE SW
Practice Address - Street 2:VALLE VISTA ES
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-2822
Practice Address - Country:US
Practice Address - Phone:505-836-7739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM57431582Medicaid